New Insights into Diagnosing Bone Diseases

Osteoporosis increases the risk of fracture significantly. The precise fracture risk stratification and diagnosis of osteoporosis are therefore critical. However, the current guideline solely depends on the patient’s bone density. The WHO classification and diagnosis of osteoporosis are based on T-score, which compares patients’ bone density with the reference group (young Caucasian female). As a result, bone quality, which is an equally important component of bone strength, is often not accounted for the risk of fracture. A good example is a diabetes-related bone disease where the risk of fracture is high despite the preserved bone density. In this chapter, we will present the commonly encountered case of diabetes and low bone mass in a clinic and discuss how to use currently available tools to stratify the risk of fracture accurately. Also, we will present a very interesting case of high bone mass, which will provide an opportunity to differentiate the causes of osteopetrosis. Lastly, we will describe a rare case of rickets and review the evaluation of rickets and its broad differential, which stress the importance of early diagnosis.